Two guiding principles underpin the recommendations in this document:
All adults (including pregnant women), adolescents and children with unknown HIV status presenting with the conditions included in these guidelines should be offered testing for HIV immediately.
All known HIV-infected adults (including pregnant women), adolescents and children presenting with the conditions included in these guidelines should be evaluated (by clinical criteria or CD4 count) for eligibility to initiate ART.
These guiding principles are consistent with the recommendations included in WHO’s Consolidated guidelines on general HIV care and the use of antiretroviral drugs for treating and preventing HIV infection (WHO, 2013). In generalized epidemics, provider-initiated testing and counselling should be recommended to everyone attending all health facilities, including medical and surgical services; sexually transmitted infection, hepatitis and TB clinics; public and private facilities; inpatient and outpatient settings; mobile or outreach medical services; services for pregnant women (antenatal care, family planning, and maternal and child health settings); services for key populations; services for infants and children; and reproductive health services. In concentrated and low-level epidemics, provider-initiated testing and counselling should be recommended in all health facilities for specific populations, including adults, adolescents or children who present with signs and symptoms or medical conditions that could indicate HIV infection.
Early treatment initiation is associated with clinical and HIV prevention benefits, improving survival and reducing the incidence of HIV infection at the community level. Current guidance (WHO, 2013) recommends that national HIV programmes provide ART to all people with HIV with a CD4 count of 500 cells/mm3 or less, giving priority to initiating ART among those with severe/advanced HIV disease or a CD4 count of 350 cells/mm3 or less. It also recommends initiating ART in people with active TB or hepatitis B coinfection with severe liver disease, all pregnant and breastfeeding women with HIV, children below 5 years and all individuals with HIV in serodiscordant relationships, regardless of CD4 cell count. (See ANNEX 1 for more details.)
Using simplified, less toxic and more convenient regimens as fixed-dose combinations is recommended for first-line ART. Ideally, once-daily regimens are maintained as the preferred choices in adults, adolescents and children older than 3 years. For children younger than 3 years, this possibility may not be there as yet.
Another consideration in managing these opportunistic conditions is the WHO Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults (WHO, 2006), which are currently being updated to indicate that individuals with any of the conditions mentioned in this document should be taking this drug long-term.
In some of these conditions, personal hygiene is an important preventive and care measure. Basic skin hygiene practices should be observed, and patients should be advised of the measures they can take themselves and for their families, especially infants.
When any of the conditions referred to in these guidelines do not respond to the recommended treatment, referral to a higher-level health facility should be considered.
